A person can bleed to death in the time it takes an ambulance to arrive. Whoever is already there is the treatment.

Where is the blood coming from?

The site decides the technique. Tap the part of the body that is bleeding — the answer that comes back is what to do with your hands there, and the one thing never to do at that site.

The first sixty seconds

1. Protect yourself, but do not let it delay you. Gloves if they are within reach, a clean plastic bag or a folded cloth if they are not. The risk from someone else’s blood is small and manageable; the risk of standing still is not.
2. Get the emergency number ringing on speaker. Say where you are first, then what you can see: heavy bleeding, from where, and whether the person is awake. Keep the phone on the ground next to you so both hands stay free.
3. Find the wound and press directly on it. Not near it, not around it — on it, with the heel of your hand or your fingers if the wound is small, through whatever cloth you have. Push hard enough that it looks like it must hurt. Gentle pressure is the same as no pressure.
4. Do not lift the dressing to look. Every peek breaks the clot that was forming and restarts the ten minutes. If blood soaks through, add more material on top and press harder — never swap the soaked layer out.
5. If it is a limb and pressure is not holding it, put a tourniquet on. High on the limb, above the wound, tightened until the bleeding stops, and write down the time. A tourniquet is not a last resort; on a spurting arm or leg it is the correct first move.
6. Keep them warm and lying down. A person losing blood gets cold fast, and cold blood clots badly. Coat, blanket, anything — and under them as well as over them if they are on cold ground.

The ten minutes

This is the part that people get wrong even when they know everything else. A clot needs uninterrupted time under pressure, and the strongest urge you will feel is to lift the cloth and check. The clock below is here to be held through — press something with your other hand while it runs, and notice how long it actually feels.

• Ten minutes is the floor, not the target. If help is on the way, hold until they take over. If bleeding has clearly stopped and you must let go, leave the packing in place and bandage firmly over the top — do not clean the wound or remove what is stuck to it.
• Anyone on blood thinners bleeds far longer. Anticoagulants and antiplatelet drugs mean a wound that would have sealed in five minutes may not seal at all. Say the drug name to the dispatcher, keep pressing, and lower your threshold for calling by a long way — including after a knock on the head with no wound at all.
• Elevation helps a little; pressure does the work. Raising a bleeding arm or leg is fine if it does not cost you pressure, and useless if it does. The old routine of pressing arteries at “pressure points” away from the wound has been dropped for good reason: it does not work reliably and it wastes the seconds that do.
• Do not give them anything to drink, and no painkillers — aspirin and ibuprofen make bleeding worse, and a person who may need an anaesthetic should have an empty stomach. A wet cloth on the lips is enough for a very thirsty casualty.

The tourniquet

Tourniquets were feared for a century on the strength of one bad idea — that they cost limbs. Military and civilian data since have been consistent: applied properly for the couple of hours it takes to reach a hospital, they save lives and rarely cost anything. The mistakes that matter are hesitating, putting it on too loose, and taking it off.

1. Limbs only. An arm or a leg. Never around a neck, never on the torso, and never over a joint — move to the thigh or the upper arm instead.
2. High and tight, above the wound. Five to eight centimetres above it if you can see it clearly; if the wound is a mess or hidden by clothing, go as high on the limb as you can. Over the clothing is fine.
3. Tighten until the bleeding stops, then stop tightening. That is the endpoint — not a number, not a feeling. A tourniquet that only slows the bleeding is worse than none, because it blocks the veins and leaves the artery running.
4. Expect it to hurt a great deal. Severe pain is normal and is not a reason to loosen it. Tell them why it hurts and that it is keeping them alive.
5. Write the time on them. On the skin, on the forehead, on a strip of tape — the hospital needs the clock time it went on, and nobody remembers it in the ambulance.
6. Never loosen it, never take it off. Releasing a tourniquet outside hospital can restart catastrophic bleeding and push acidic blood back into circulation. Only the hospital team removes it.

Packing a wound, and the places a tourniquet cannot reach

Where a limb meets the body — the groin, the armpit, the base of the neck, the buttock — there is no place to put a tourniquet and the vessels are large. These are the wounds that need packing: filling the cavity with material so that your pressure reaches the bleeding vessel instead of squashing an air pocket.

• Push cloth or gauze right into the wound, not over it. Keep feeding material in until the cavity is full and tight, using one hand to hold what is already in there.
• Then press with both hands, hard, for at least three minutes without stopping — and longer if it is still bleeding. This is exhausting and it is the whole treatment.
• Anything reasonably clean will do: gauze, a T-shirt, a tea towel. Sterile is better, present is what matters.
• Do not pack a wound in the chest, the abdomen or the eye, and do not pack a neck wound tightly — for the neck, press firmly on the bleeding point with your fingers and never wrap anything around the whole neck.
• Leave the packing in. It comes out in an operating theatre, not on the kerb.

Shock, and the person who is still talking

The most dangerous casualty is the one who looks manageable. Bleeding is compensated for by the body until it suddenly is not, so a pale, chatty, apologetic person can be much closer to collapse than they appear.

• Skin first: pale or grey, cold and clammy to the touch, sweating even though they feel cold.
• Then the pulse and breathing: fast and weak, breathing quick and shallow.
• Then the head: restless and anxious, then confused, then drowsy. Extreme thirst is common and so is nausea.
• Then it collapses, and it does so quickly. Someone who was talking a minute ago can stop responding, which is why you say what you can see on the phone rather than waiting for it to get obvious.
• Lay them flat on their back and keep them there. If they are not fully awake and are breathing, roll them onto their side so the airway stays clear — while keeping pressure on the wound.
• Keep the heat in. Blanket, coats, something underneath them. Getting cold makes bleeding worse in a measurable way, and it is the easiest thing on this page to get right.

Particular wounds

• Something is embedded — glass, a knife, a spike. Leave it exactly where it is; it may be the only thing holding a vessel shut. Press around it, build up padding on either side, and let the hospital remove it. The same goes for a nail through a hand or a fishhook.
• A part has been cut off. Control the bleeding first, then find the part: wrap it in clean damp cloth, seal it in a plastic bag, and put that bag on ice or in cold water. Never let ice touch the tissue and never wash it in anything. It travels with the patient.
• A nosebleed. Sit up, lean forward, and pinch the soft part of the nose — not the bony bridge — firmly for ten to fifteen minutes without releasing to check. No tipping the head back, which sends blood down the throat. If it is still going after twenty minutes, if it started after a head injury, or if the person is on blood thinners, get medical help.
• Heavy bleeding after childbirth or a miscarriage. Soaking a pad in under an hour, passing large clots, or feeling faint after giving birth is an emergency and not something to sit out at home. Postpartum haemorrhage is one of the great causes of maternal death worldwide and one of the most treatable when it is reached in time.
• Blood being coughed or vomited up, or stools that are black and tarry, mean internal bleeding. Emergency number, keep them still, nothing to eat or drink.
• A crush injury or a limb trapped for a long time needs the ambulance service to be told exactly that, because releasing the crush has its own dangers. Control visible bleeding, keep them warm, and do not spend your strength on freeing them if professionals are minutes away.
• Children bleed the same way in less volume. A blood loss that an adult would tolerate can be critical in a small child, so the threshold for calling is lower, not higher. Pressure is identical; a tourniquet on a small limb still goes high and tight.

The kit, and where it should be

Almost every avoidable bleeding death happens somewhere ordinary: a kitchen, a building site, a road. The equipment is cheap, small and almost never bought.

The words on the phone matter more than they should. Dispatchers prioritise from what you say, and most callers describe the accident instead of the bleeding. Say the place first, then the six things that change the response:

Afterwards — for them and for you

• Small wounds still need a decision. A cut that gapes open, will not stop after ten minutes of pressure, is on the face or a joint, was made by something dirty or by an animal or human bite, or has numbness or weakness beyond it, needs seeing today — and stitches work best within a handful of hours.
• Ask about tetanus. Any dirty or deep wound is a reason to check the last dose. It is a one-question conversation that occasionally prevents a catastrophe.
• Watch for infection over the next days: spreading redness, increasing pain after day two, swelling, pus, a red streak running up the limb, or a fever. That is a same-day appointment, not a wait-and-see.
• If their blood got into your eyes, mouth or an open cut of yours, or you were stuck by a needle, wash it out generously and get medical advice quickly rather than at leisure — the preventive treatments that exist are time-limited. Straightforward blood on intact skin is washed off with soap and water.
• Expect the images to come back. Intrusive replays, poor sleep and jumpiness for a couple of weeks after a bloody scene are the normal response of a normal nervous system, not weakness. Talk about it with someone; if it is still owning your days after a month, that is what a doctor is for.
• Faintness at the sight of blood is common and not a disqualification. It usually eases once your hands are busy. If you know you go down, sit or kneel while you press, so that fainting means slumping rather than falling.

The drill: 16 decisions

Sixteen ordinary scenes — a workshop, a kitchen, a cycle path, a child at a party. Most have an instinctive answer that costs blood. Pick your move; every answer explains why.

The card

Print it and tape it inside the first-aid kit, the car, the workshop.

🖨️ Print the card